Dreading my nutritionist appointments

aavamavaa

I have my two week follow up appointment on Monday. I am really looking forward to being weighed, especially since the last time they weighed me was a week before I started the pre-op diet. However, I am NOT looking forward to dealing with the nutritionist.

My allowed foods only allows low fat versions of food and I do not do that. From my experience, fat is not what has gotten me into trouble: sugar and starches are responsible. I feel like fat is unfairly maligned and I'm grossed out by hyper-processed low fat products. This was a constant source of conflict during the medical weight management phase and I can't imagine it will be any different now.

My nutritionist's ideas of healthy fats include margarine and "low fat spread." My husband didn't believe me that "low fat spread" was a thing.

I have only just transitioned from 100% protein shakes to pureed so there are only a few days of data for them to nitpick. But I have used real mayo, eggs and not egg whites, full fat yogurt, full fat cheese (all 1T of it), a tiny bit of avocado, boneless skinless chicken thighs not chicken breasts. I am meeting my protein and fluid goals. They never gave me calorie or macronutrient goals (other than protein) and would be fine if I wanted to eat oatmeal and applesauce, just no fat.

I hate disobeying doctor's orders. I really want to please them, but this is not something I want to compromise on. But I don't really know what to do.

garber6th

I am going to apologize in advance if what I am going to say offends you... but I think if any of us that had surgery were experts in nutrition, we wouldn't have gotten to the point where we chose to have surgery. Our experiences clearly got us to where we were. I am not saying that at some point some amount of fat can't be included in our diets, but two weeks out and you want to deviate from the plan? From what I have seen, those that are the most successful are those that listen to their surgical team and do what they are supposed to do. They are the subject matter experts.You aren't following the plan to please them, you are following it because it's best for you and your success. My fear is that when someone deviates from the plan, it could be the start of a slippery slope.

Take a minute and read this post from the other day for a little insight -

http://www.myfitnesspal.com/topics/show/1389664-beware-tough-love

This surgery is an amazing tool and it gives us the chance to give ourselves awesome gifts - health and quality of life - but we have to use this tool properly. I wish you all the best and much success.

sarahViolet1977

I agree with the previous poster. Having surgery is a change if life; you have to be committed to changing your eating habits in order to be successful. I hate low fat foods too but since that is what my doctor and nutritionist said I need to eat, that's what I've been doing. I wish you the best of luck.

ChelleDJM

I agree with the original poster. I use real butter and full fat cheeses. I do no fat greek yogurt and lowfat milk and cottage cheese. Overall, my rule is natural over chemicals. I do choose low fat proteins for the most part and I use low fat dressings, but only the ones with yogurt that are natural. Sugar and excess fats will be bad, but I would rater have a half ounce of a fabulous cheese than an ounce of fat free nasty.

Mangopickle

The post surgery diet (liquids,purées,etc.) isn't forever, just to allow healing without complications from rich food causing increased acid production and accidental dumping syndrome from high sugar foods.
After you are back on normal foods you have to be hyper vigilant about calorie control whether or not you do full fat or fat free. You must maintain a deficit or you will not lose. You will have to watch sugar and sugar alcohols or get a nasty case of dumping syndrome. You will have to choose to let go of foods that interfere with your wt loss. I dumped mayo but kept butter, I dumped regular cream cheese but kept whip cream.

aavamavaa

"The post surgery diet (liquids,purées,etc.) isn't forever, just to allow healing without complications from rich food causing increased acid production and accidental dumping syndrome from high sugar foods."

Can you provide a citation for that claim? It doesn't really make sense to me regarding fat intake based on my understanding of the way fat is digested (it's not really digested in the stomach at all but the small intestine). I don't eat sugar, sugar alcohols, or starches so that's not an issue.

Here's the thing. Nutritionists give bad advice. I've heard some howlers from registered dietitians over the years and I've definitely heard stories from other patients. I also believe in being a well educated patient. I do my best to keep up with the research (as much as I have access to without a university library at my disposal). The state of understanding surrounding nutrition is pretty dismal and I'm skeptical of any nutritionist who claims otherwise. I chose to have this surgery not because I'm bad at losing weight but because I believe it will be a tool that will help me stay on the only diet that has ever worked for me: a ketogenic diet. I've made my choice regarding fat intake and I'm going to stick with it. I just hate having to argue my case before nutritionists every month. I hated it pre-op and I dread it now.

BTW if I ate 80 grams of protein and 50 grams of fat, I'd hit 770 calories on the nose. I think that sounds like it's in line with what other people are eating calorie-wise, and it would probably be a stretch to eat 50 grams of fat.

asia1967

I am going to apologize in advance if what I am going to say offends you... but I think if any of us that had surgery were experts in nutrition, we wouldn't have gotten to the point where we chose to have surgery. Our experiences clearly got us to where we were. I am not saying that at some point some amount of fat can't be included in our diets, but two weeks out and you want to deviate from the plan? From what I have seen, those that are the most successful are those that listen to their surgical team and do what they are supposed to do. They are the subject matter experts.You aren't following the plan to please them, you are following it because it's best for you and your success. My fear is that when someone deviates from the plan, it could be the start of a slippery slope.

Take a minute and read this post from the other day for a little insight -

http://www.myfitnesspal.com/topics/show/1389664-beware-tough-love


This surgery is an amazing tool and it gives us the chance to give ourselves awesome gifts - health and quality of life - but we have to use this tool properly. I wish you all the best and much success.

I agree, for the recovery period and the until you are allowed to introduce full foods you should follow the plan. When I introduced full foods than I started to incorporate more full fat foods. I still drink 1% milk, eat 1-2% cottage cheese, regular brick cheese.
However it sounds like you have already made up your mind what you are going to do. I do wish you the best, there is always exceptions to the rule.

authorwriter

I'm not sure I'm reading your post right. Are you pre-op?

I agree regarding the fake fats. You have the choice to just not eat them. I haven't had any in years and years. Regarding no fat dairy products, read the labels. Daisy brand doesn't have any added ingredients. You want no-fat without added starch to make up for the fat. That's why greek yogurt is so popular. It's strained more, so more milk solids to thicken it up. Kroger carbmaster milk, non-fat, is very high protein and low-carb.

I understand what you're saying about the fats, I feel the same way. Too many 'healthy' foods have junk added to them to replace the fat that's been removed. Here's the deal, you're not required to eat them if you don't like them. You still have plenty of choices to help you meet your protein goals - beans, fish, lean meats, none of which require the addition of any kind of fat, fake or not.Fruit and veggies are fat free. There's no requirement to add anything to them.

Rather than focus on the stuff your nutritionist requires that are upsetting you, choose to leave those out of your diet and instead, concentrate on those foods she recommends that do not upset you.

authorwriter

never mind. just re-read, you are post-op.

My advice? Keep your diet to yourself. Don't argue with the nutritionist. Why do you even see her if you're arguing with her? If you're losing weight on a ketogenic diet, keep right on losing. A ketogenic diet is the basis for the post-op diet anyway. Being in ketosis is what makes us lose weight. Oatmeal and other grains aren't going to help you do that, though. My surgeon keeps us on lean protein, eggs, protein shakes and veggie and some fruit for basically, as long as we can. They haven't recommended fake fats to replace real ones. Butter is off the menu. Olive Oil is not. We can use full fat real mayo if we want. Our portion sizes are so small, what's it matter?

ATXHeather

I understand where you are coming from. I do NOT like to eat processed or artificial foods. Like another poster said, I prefer real foods over processed foods. I understand, though, why my doctor wants me on low fat right now (I am 1.5 weeks post-op). That doesn't mean I have to eat processed crap. It takes more effort to find foods that aren't processed but it's not impossible. For example, I had to really look to find a fat free greek yogurt that didn't have artificial flavors and colors. But I found one. I also know that this stage is temporary so I follow my doc's orders. I understand you not wanting to eat "low fat spreads" and fake foods. But why not have chicken breast instead of thighs for a little while? Why not get the low fat greek yogurt instead of the full fat or the 2% cottage cheese instead of full fat? The lower fat versions don't always mean fake foods. So why not opt for those?

Also, I'm surprised that you don't have a calorie goal. I am only in the full liquids phase but my doc wants me between 600-800 calories. That goes up as I progress through the stages, but never higher than 1200. Eating full fat foods means you don't get to eat as much and it will make it harder to meet your protein goals and stay within your calorie range. What's the point of the surgery if you plan to go back to eating high calorie?

itsdreday

I know you don't have a calorie goal, but how many calories are you eating a day? I was on 500 cal for the first 2 weeks, then 600-800 weeks 2-8. 800-1000 ever since and will transition to 1000-1200 at my 6mo follow-up (sleeved 3/4). That seems pretty standard across the people here. The calorie deficit is the key.

Mangopickle

True, the fat digestion happens further down the gut but it does delay gastric emptying which is why it satisfies so well. However, sleeve surgery is well known for causing as well as exacerbating reflux and a low fat diet is recommended while the stomach heals. That is just standard practice for prevention and treatment of reflux. As for the nutritionist, if you were a marathoner she would probably be throwing peanut butter, olive oil and coconut oil in your lap. But she treats morbidly obese pts every day who have become accustomed to a high carb high fat diet. You are correct that it is more the carbs (specifically fried carbs) that are usually the problem, not just random fat. And since morbidly obese people are usually crap at portion control the Nuts tend to focus on low fat to keep volume high and calories low for better outcomes. This is why the low fat spiel works for the vast majority of pts. Very few pts are as committed early on as you are to a ketogenic lifestyle. I applaud you for choosing the tougher path of low volume full fat. It is more natural to limit the high glycemic carbs that have become an unnaturally large portion of our diet. I suspect that your Nut and surgeon will come around as your excellent wt loss will show your commitment to high protein and calorie deficit. I eat bacon for breakfast most days, I cook with ghee, coconut oil and olive oil. I do not own or plan to own Pam spray. My Nut thought I was kidding when I quit eating wheat,rice,potato and processed corn. She thought I was a bit odd for making my own chick pea wraps and mung bean flat breads, parsnip and kabocha chips. She never expected me to go lower than 180 lbs and orient my life around a normal BMI instead of overwt. But, here I am 263 days later and within 1 lb of a normal BMI for ht. unlike you some of my full fat favs had to go. I just couldn't portion control peanut butter or flavored full fat yogurt so hello pb2 and light fit vanilla Greek. Based on your past significant wt loss I suspect you have found a workable solution. Once you have your 3 month visit and you are down 50+lbs I doubt they will say much. My nut was more of a fanatic about weighing and measuring to train us to really understand our actual calorie intake and our base calorie burn. At the end of the day it is all about achieving deficit. Good luck.

GraceByMySide

I just dread the NUT appointments because of past experience. So much food shame from my past! I was sent to a NUT at the age of 10 and it's always felt like an inquisition... My NUT is really awesome, but it's still hard for me to get past my feelings of being judged and shamed.

katematt313

First, I will say that I hated the first nutritionist that I met with. Ahhh, Katrina. She was blonde, adorable, sneered during our entire first appointment, and couldn't have weighed more than 100 lbs soaking wet. I got the impression that she thought fat people were lazy and stupid - when I am anything but. She, herself, was not a rocket scientist.

For example: she gave me a photocopy of the USDA "my plate", and said to me "this is a 9" plate - what you should be using to serve your food on". When I asked, "how can a 9" plate fit on 8.5x11 paper?", it didn't go over well. My second appointment was just as bad. I felt condescended to, and it made me intolerant to the whole idea of nutritional counseling.

I ended up requesting a third visit go go through things again, and asked for different nutritionist. I had to go to another office location to accomplish that. When the office manager asked me why I did that, I ratted out Katrina for being the judgmental B**** that she was, and the office manager told me it was not the first complaint that she had received. I felt better and the second nutritionist was an improvement. So, I get it - nutritionists can be judgmental idiots.

Second, before I had WLS, I had practiced a strict LCHF, ketogenic diet for 2 years, with a 40 lb weight loss. I plateaued for more than a year. Then, I got pregnant, my OB said I couldn't be low carb and pregnant safely, I had the baby and gained all the weight back, then could never manage to get back on LCHF again because I had opened the door to bread and sweets and was thoroughly addicted.

When I made the decision to pursue WLS, I was THOROUGHLY indoctrinated in the LCHF mentality. Carbs are evil. Fats are good and necessary and go face-first into them. The WLS-office nutritionists were okay with my "carbs are evil" mentality, but could not get behind the "eat fat freely" part of LCHF. I had SUCH a hard time with this piece of the diet. I was up front with them about my mental struggle. I think that the second nutritionist appreciated this, and she took the time to sit down with me and educate me about why the office made the dietary recommendations that they did, and credited me with knowing a good deal about nutrition.

I felt empowered. I knew I was standing in between two different nutritional theories, and I had a decision to make - would I stubbornly insist that I - a 228 lb T2 diabetic with HBP, PCOS - knew better, or would I just suck it up and make the best by following their dietary plan, complete with fat restrictions?

I followed the dietary advice from the office. It was a good decision.

Look, a big part of why WLS works is because we eat extremely low calorie diets. If you are getting 3-4 x 2 oz portions of meat per day, with some veggie sides and maybe a protein shake, you are going to get between 700-1000 calories. Unless you are eating fish at every meal, your protein is going to be tied up with some fat. My average meal is 200-250 calories, and snacks are about 100 calories. I try to make each meal and snack protein heavy.

Every time you add on a pat of butter, you are adding 100 calories. Every time you add on a tbsp of mayo, you are adding 70-80 calories. Every time you add a tsp of olive oil, you are adding 100 calories. If you do that with every meal, that can add up to an additional 300 or more calories per day. Also, because fats like butter, mayo and oil are low-volume, slippery and coat what you are already eating, the calories that you get from them aren't going to make you any fuller.

I am not going to say that I won't put a little bit of butter, sour cream or mayo on some foods. Tuna or egg salad - hello??!! I just make sure that I count it, and that I only have it once in a while.

I have learned to cook without fat, or with very little added fat. It is a transition, and it is hard. I have always been an excellent cook, but this change really challenged me to figure out how I could brown foods properly, make sauces and soups taste rich, etc. Now, I start a sautee with a little Pam, add more low or no calorie seasonings, and add a couple of tablespoons of water to the sautee to get things softened before they brown. Think about how you make taco meat, according to their directions. That technique works for so many things.

TODAY: I am two months post-op. I weight 191 lbs and have dropped just about 40 lbs since late May (about 2 months ago). I continue to lose and lose. Monumentally, my lowest weight on LCHF/ketogenic was 196 lbs (about 2 years ago), and I still had diabetes, low blood pressure, PCOS, and several other symptoms of metabolic disorder. When I again hit 196 just a week or two ago, post-WLS, I had no diabetes and took no diabetes meds, my BP is good, and I am physically smaller at 196 than I was 2 years ago (I fit into smaller clothes).

So, it has been good for me. It could be good for you. You are an adult and you can make your own decisions. So, you have to decide who knows better - you or your medical team. But, you are ultimately the one who lives with the consequences of those decisions. People who go off the diet develop bad habits and get fat again. It happens all the time. Don't let that be you.

Also - I just posted a comment today that I think is also relevant - do you want to be an "eat to live" person, or a "live to eat" person. These are two distinct roads, and I think that people who are particularly successful with WLS end up being the former, rather than the latter, because "live to eat" is dangerous, especially for those of us with food addictions and all kinds of triggers to delicious stuff.

pawoodhull

My husband is a heart patient and the nutritionist for his plan told us years ago, very little fat for his diet and make it real fat. The fake fats also have things in them that are not good for the body. So a little butter or a little mayo is fine, but a little and not often.

I am three years out and from my experience, you will most likely have less success if you modify the plan of the experts than if you follow it. Now, before you stop reading, I agree with you about "fake fat". I prefer natural. Most low fat items are natural in the sense that they've had some of the fat removed. So I will do low fat milk or yogurt. I use mayo with olive oil, not low/no fat, a different, healthy fat. Our bodies do need some fat, but we need the healthy kinds of fats and maybe that's what you should be concentrating on. If you look at my food log, you will not see a lot of fat daily outside my coffee creamer. I just don't use a lot of it because of the calories.

Anyway, success if the priority here and once you get to goal and maintenance you can tweek to your heart's desire. You know?

bikrchk

My program only required a NUT eval pre-op. All post op care comes from medical appointments and support groups lead by the bariatric nurse coordinator. While well "educated" up front, and since via avenues mentioned above, I've kind of been on my own through this process. While I was in my losing phase, I chose lower fat options, not ALWAYS, but most of the time. Less butter, more olive oil, etc. Now that I've reached goal, and gone a bit below, I'm working in some full-fat cheese, real eggs and higher calorie options. I exercise 5 days per week and most days I have to work to hit my calorie goals for maintenance without eating complete crap. I had to quit the nutritional program I'd signed up for at work, (for the insurance rate bonus) because my Bariatric diet has NEVER looked like the typical USDA recommendations. How many servicng of veggies do I get per day? Sometimes nada. My instructions have been to finish my protein and IF there's room, have a bite of veggie. I take copious supplements on a schedule and will for the rest of my life to compensate. My blood chemistry has been perfect and my medical team is pleased with my progress. Even the NUT who evaluated me 1 year ago gave me those instructions... Protein above all else and take your vitamins. Sounds like you need a NUT trained in the bariatric diet, (and with a better chairside manner).

homerismyhero

I have a hard time with all of the processed food too- so, if it's full fat, but fits in my nutritional plan- I eat it- as long as I'm comeing in at about 900 cal a day, meeting my protien goals and active- then it works.

garber6th

Low fat does not always equal processed. It's totally possible to eat low fat without eating overly processed foods, and full fat is not necessarily the only option. I still believe tweaking the plan two weeks out is risky. Once someone is back on solid foods, if full fat foods agree with you and you can fit them into your calorie goals, it's a completely different story, but while your stomach is still healing, I would go with the plan given to me by actual medical professionals. I see a lot of posts from people who want to change things early on and honestly it surprises me. If we knew what we were doing prior to surgery, if we knew better than our surgeons and their teams, we probably wouldn't even be in this group.

homerismyhero

It's the overly processed dairy that grosses me out- I feel like it's one molecule away from being tupperware. I'd rather have butter, eggs, and part skim cheese, the only thing that doesn't gross me out is the Dannon Light and Fit 80 cal greek yogurt- I still prefer the taste of 2% greek yogurt- but can't always afford the additional calories so it's a compromise I can make.

jennielou75

I was obsessed with fat after my op. I averaged 10-15grams of fat every day. My skin suffered and lots of my hair fell out. My nails even started splitting. My nut told me to up my fat but 'good' fats. Olive oil, salmon, avocado. I was told to use natural fats but to weigh it all and try not to go over 25 grams. I am now 2 years out and average 35 grams of fat. My skin, hair and nails thank me. Keep as low fat as you can but own and record the fat you eat.

I eat normally and watch my weight normally, I own my good days and my bad days. I am not perfect. Food got me into a mess, surgery and hard work got me out of it. I still enjoy food but I also love the fact that I control food. Food does not control me.

pawoodhull

I was obsessed with fat after my op. I averaged 10-15grams of fat every day. My skin suffered and lots of my hair fell out. My nails even started splitting. My nut told me to up my fat but 'good' fats. Olive oil, salmon, avocado. I was told to use natural fats but to weigh it all and try not to go over 25 grams. I am now 2 years out and average 35 grams of fat. My skin, hair and nails thank me. Keep as low fat as you can but own and record the fat you eat.

I eat normally and watch my weight normally, I own my good days and my bad days. I am not perfect. Food got me into a mess, surgery and hard work got me out of it. I still enjoy food but I also love the fact that I control food. Food does not control me.

Well put Jennierlou! It's all about portion control, counting all the calories you consume and staying away from bad fats that will raise the cholesterol and clog the arteries. Even skinny people need to avoid those bad fats.